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Mid-Term Follow-Up of Haemodynamic Performance of the St. Jude Medical Trifecta Aortic Bioprosthesis
Amir Sepehripour, Jacob Chacko, Kulvinder Lall.
St Bartholomew's Hospital, London, United Kingdom.

OBJECTIVE: The St. Jude Medical Trifecta aortic supra-annular bioprosthesis is regarded as the next generation in pericardial stented tissue valves. The unique design of tissue leaflets attached to the exterior of the valve stent provides unrivalled in-vivo mean gradients and haemodynamics. The aim of this prospective study was to evaluate midterm haemodynamic performance.
METHODS: One hundred and thirty five consecutive patients undergoing aortic valve replacement using the St. Jude Medical Trifecta valve at a single UK centre over a 36-month period were included in this study. Patients undergoing concomitant cardiac procedures were included. All implanted valves were 19, 21, 23, 25 and 27mm in size. Assessment of haemodynamic function was carried out using transthoracic echocardiography pre-operatively and at follow-up, as well as transoesophageal echocardiography intra-operatively.
RESULTS: The study population consisted of 135 patients (73 male, 62 female). Mean age was 77.5±5.2 years. Implanted valve sizes were 19mm (n=13), 21mm (n=35), 23mm (n=57), 25mm (n=23) and 27mm (n=7). Overall mean post-operative pressure gradients were 7.46±3.7mmHg (mean) and 15.36±4.9mmHg (peak). Subgroup mean post-operative pressure gradients were 7.26±7.2mmHg, 7.56±2.9mmHg, 8.67±4.3mmHg, 7.41±3.9mmHg, 7.36±2.9mmHg, for the 19, 21, 23, 25 and 27mm cohort respectively. Overall mean post-operative left ventricular ejection fraction was 61±3.1%. Overall mean effective orifice area was 1.81±0.5cm2. Moderate-severe paravalvular leak was observed in one patient and mild-moderate leak in another. Otherwise there were only 17 patients with trivial regurgitation.
CONCLUSIONS: These results of our experience demonstrate excellent haemodynamic performance of the Trifecta bioprosthetic valve.

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